Tuesday, July 21, 2015

It’s not often that your expectations are exceeded so completely, but
Africa has done nothing but surprise me.Whether through the adventures, the hospitality, the accommodations, or the work, never would I have imagined so many
things to go so right this summer.

Since my last blog post, I was given the chance to immerse
myself in the field of global health and development, working with youth in Uganda’s rural Mpigi district.Getting on the ground to participate in interventions
at the community level was my primary goal for the summer.I realized that goal, and much more.My education until now –
all the books, lectures, podcasts - only took me so far. From here the real learning begins.I feel my own beliefs and assumptions in
constant flux, and for a lifelong student it is a sensation I crave.

A group of bodaboda (motorcycle taxi) drivers I interviewed on my first day in the field

As part of its strategy over the next few years, Twezimbe Development Foundation will shift a portion of its focus from broad economic and health development to solving youth
specific challenges.Although Uganda has
seen rapid economic growth in the last two decades, an explosive population
boom coupled with vast inequality between rural and urban investment has
created a dire situation for many of the nation’s young people.With dwindling opportunity for employment and
subpar human development, Uganda runs the risk of disenfranchising an entire
generation, paving the way for social strife and potential conflict.

Over the course of seven days I interviewed 33 groups including
secondary school students, teachers, health workers, and various youth
professional organizations.It was an
incredible experience, among the most intellectually challenging and rewarding
of my graduate education. Every
encounter provided a chance to learn, whether from an hour-long meeting with 25
students to a quick conversation with a staff member in the back of a
truck.I was a sponge, soaking it all in,
and resisting any urges to form concrete conclusions.

My fieldwork began after moving into Madame Amelia Kyambadde’s
(Ugandan Minister of Trade and Matron of Twezimbe) country home in Mpigi.Her house was a beautiful, horseshoe shaped
ranch-style that sat on a hill overlooking 40 acres of thriving coffee and
banana plantations.In the mornings the
maids opened the doors and windows to invite the warm light and melodic
African countryside inside.I was
cooked three meals a day of traditional Ugandan fair, a culinary style heavy on
goat meat and starches such as Kasava (like a bland potato) and Matooke (an
unsweetened mashed banana).

Walking through Madame Amelia's plantation in Mpigi, Uganda

Although English is the official language, Ugandans living
outside of Kampala are much more comfortable speaking one of their native
dialects. Most of my interviews took
place with the accompaniment of Bashir (an MC by night and Twezimbe’s Media and
PR Officer by day) to translate.After seeing him perform as a 17 year old MC,
Madame was so impressed with his skills that she took him on as a protégé,
financing his secondary and university educations and hiring him to work for Twezimbe. Bashir’s translation skills became
essential to completing my work. He used
his MC prowess to warm up the audiences and win over any detractors.He translated quickly
and succinctly, taking diplomatic liberties when his intuition directed.His verbal agility allowed me to react
swiftly and improvise rather than progress down a canned line of questions. With him as my voice, I was filled with
confidence knowing that any stumble or stutter on my part would pass as
charisma.

Each morning Bashir and the
Twezimbe field offices planned out a full day of meetings with youth groups
and health centers.At 9 AM we’d hop in
the Twezimbe 4x4 truck and race across Mpigi’s back roads at the speed of a
Dakar Rally competitor.Our driver Omar
claimed to have picked up his appetite for alacrity after seven years of keeping
up with Madame’s dizzying political schedule.My daily routine started to feel like that of a politician’s, with debriefings between events and waving crowds from those who recognized the
Twezimbe truck for its ties to Madame.

Me with a village of brick makers

Although the various groups I met
with were unique and suffered their own diverse set of challenges, some themes
were all too common among the community.I’ll try to highlight a few of these themes below:

Inadequate Education:

Lack of free and compulsory secondary education has forced many youth
to drop out of school.With little to no
skills, these youth are condemned to a life of dangerous, menial work such as
bodaboda (motorcycle taxi) driving or brick making.School dropouts are at higher risk for STIs
such as Gonorrhea and HIV.Young females
are at higher risk for teen pregnancy and marriage.In fact education is considered foundational
for reducing population growth, with female literacy and job participation
widely considered to be decisive factors in reducing high fertility rates.

Archaic curriculums and lack of career guidance has ill-prepared many
youth for the Ugandan job market.Based
on the British education system and basically unaltered since the 1960’s, the
Ugandan school curriculum is too theoretical, training millions of youth for
white-collar jobs that don’t exist. There is a push to emphasize vocational skills and
entrepreneurship, training youth to be job creators instead of job seekers. Unfortunately lack of career guidance
has left most youth without any idea which vocations are worth their time and
how to go about pursuing them.

Mpigi youth financially unable to attend school, now working as sand miners

Isolation & Fragmentation:

Lack of transportation and Internet has isolated people in the rural
communities, preventing expertise sharing and access to wider markets.This has made it difficult for people to know
which jobs, services, and products are in most demand.One of the most heartbreaking mistakes many
make is to sell their land with the belief that life in the city or in some
other profession offers more hope.Agriculture
is the backbone of the Ugandan economy, and land here is among the most fertile
in the entire world. It is said that if
you have land, you will never starve.With
better guidance on farming techniques, information on crop demands, and access
to markets, many farmers could exponentially improve their profits.

Lack of Access to Capital:

Most youth would like to start their own business or get into farming
but lack the capital to begin.As poor
individuals, traditional banks and lenders consider them unserviceable.Microfinance was designed specifically for
the poor, offering loans and banking on a small scale.Due to lack of education, Internet, and
transportation, youth are not sure how to access these lenders.

Inadequate Public Health:

With poor health both a cause and consequence of poverty, it is hard
to imagine any transformative change taking place in Mpigi until the large incidences
of HIV, Malaria, malnutrition, and teen pregnancy are remedied.As preventable challenges, careful planning
and coordination on the part of the government could greatly curb these issues.Yet a few hours spent in Mpigi will reveal
that public health care falls far short of need.

Public health centers in Mpigi, although free of charge to residents,
are few in number, and suffer massive medication and staff shortages.Waiting rooms are insufficient
and easily overflow.Inadequate
resources hamstring health education, with insufficient and ununiformed
outreach to schools and communities.Because
of lack of transportation, simply getting to a health center is a major
challenge.All of these factors have led
to poor health-seeking behavior among Mpigi youth.Many delay treatment until the later stages
of their ailment when treatment becomes more costly and complicated. Additionally, despite growing awareness, contraception use is still misunderstood and
questioned.

Madame Amelia and I

I couldn’t help but think
that most of these challenges were only consequences of some deeper issue.My intuition tells me that so much of the
blame lays on the government, that their corruption is stymying the development
of infrastructure and public institutions that would help evenly distribute
Uganda’s growing wealth.I also wonder how
much good large western aid organizations can do if they are ultimately working
through the government and its agents.Is
it possible that they are perpetuating corruption and helping to sustain the
status quo?A little time spent in
Kampala will reveal that Western NGOs occupy the richest neighborhoods and pay
some of the heftiest salaries in the entire country.This can’t be efficient use of
resources.

Maybe the answer to transformative change is through small, grassroots
organizations such as Twezimbe, with their micro-level, piecemeal interventions.Their size allows them greater flexibility, accountability,
and community buy-in.They don’t seek broad stroke changes, rather
simple, observable and direct objectives: lobbying for a power line to an
isolated strip of homes, providing new hoes for a farming cooperative, building a
maternity ward in a health center that sees more than 80 births a month.But of course the question of scale comes up,
Mpigi is just one small district in an entire Sub-Saharan region facing similar
issues.In the end I am reminded that if
there’s anything to be sure of, it’s that I’m not sure of anything.All I can do is keep an open mind and
continue to learn.

Follow the Trojans as they engage in global health projects at USC and beyond. Using the world as their campus, USC’s transdisciplinary students and faculty work together with colleagues worldwide to improve global health by educating future and current global leaders, carrying out trans-disciplinary research, and assuring that the evidence collected impacts policy change to make a difference.